Group A streptococcal meningitis with the M1_UKvariant in the Netherlands

Abstract

We analyzed over 40 years of bacteriological surveillance data to reveal a 4-fold increase in Group A streptococcal (GAS) meningitis in 2022 compared to the annual average of 1982-2021 (n=5/year). Already four GAS meningitis cases occurred in 2023 (until Feb 20th). Moreover, from May 2022 all GAS meningitis cases were caused by theStreptococcus pyogenes emm1 strains, of which 15 of the 19 (79%) belonged to the toxicogenic M1UK variant. Based on these observations, we urge clinicians to be vigilant regarding clinical sign of meningitis with invasive GAS infections, since this disease manifestation appears to have a higher than expected occurrence due to clonal replacement by the recently-emerged M1UK variant.

Group AStreptococcusstrains causing meningitis without distinct invasive phenotype

“…A report from Switzerland described nine cases of GAS meningitis registered between 1983 and 1999 across all major Swiss hospitals, again emphasizing the rarity of this disease [42]. A recent report showed an increase in the number of GAS meningitis case in the Netherlands in 2022-2023, compared with the previous 40 years, with emm-1 being the most represented M-protein variant [43].…”